The influence of stressors, appraisal and personal conditions on the burden of spousal caregivers of persons with dementia.

OBJECTIVES: The aim of this study was to explore the main and mediating influences of stressors, a caregiver's appraisal, coping, personal conditions and social resources on the burden of dementia caregivers. METHOD: The study sample consisted of 95 spousal caregivers of non-institutionalized persons with dementia. A path-analytic approach was used to test the conceptual model. RESULTS: The most important factors that were related to burden were the social and behavioural problems of the person with dementia; perceiving the caregiver role as a threat; perceived instrumental support; and the caregiver's functional health status and self-efficacy. The results showed no support for the mediating role of appraisal and coping on the relationship between the demands of the caregiving situation and burden. CONCLUSION: Although we found insufficient support for the empirical tenability of the hypothesised model, this study revealed some new findings of practical interest. The relationships found suggest that it might be possible to reduce the caregiving burden by improving the social functioning of the person with dementia, the caregiver's perceptions and the caregiver's capacity to function in daily life.

Business orientation and the willingness to distribute dental tasks of Dutch dentists.

AIM: Dentists have a dual professional role: they have to focus on good oral health in their patients and, at the same time, they have to organise their practices. The aim of this analysis was to assess the extent to which dentists can be seen as business-oriented and/or willing to delegate to dental team members and others, and to investigate which personal and practice characteristics of dentists can be regarded as determinants for these two aspects of their professional role. METHOD: The data were collected in 2000 by means of a written questionnaire sent to a random stratified sample of 790 dentists. RESULTS: 607 (77 per cent) dentists responded. Multivariate regression analysis showed that business oriented dentists distinguish themselves by having larger practices and a higher level of professional satisfaction. Furthermore, although to a lesser extent, on a regular basis, they treat patients from colleagues in the practice. There are proportionately fewer women dentists in this category. Dentists oriented on task distribution can also be typified by working in larger practices, but in addition they have a greater preventive treatment philosophy and have more hours of support provided by oral hygienists. CONCLUSION: Among Dutch dentists there exist clear differences in the way they take on their role as dentists with regard to business orientation and their willingness to distribute dental tasks.

Determining the explanatory potential of variables.

A meta-analysis may not be the most appropriate method for the extraction of information on independent variables from the scientific literature. A formal quantitative review method is proposed for reducing a literature review variable list to a manageable list of explanatory variables. The proposed method synthesizes the information in a standard literature review into two steps. First, the hypothesis "independent variable 'X' had no effect on utilization" is tested by means of binomial, one-sided testing. If it is rejected, then the hypothesis "The effect of independent variable 'X' is as likely to be in the same direction as it is to be in the opposite direction" is tested, by an extended version of the binomial formula. In two steps, the presence of a consistent direction of significant effects is calculated. This method is tested on dental utilization publications. It is concluded that the method is an effective tool for the creation of a manageable variable list.

The effects of physiotherapy for female urinary incontinence: individual compared with group treatment.

OBJECTIVES: To compare, in a randomized trial, the effects of individual and group physiotherapy for urinary incontinence in women referred by their general practitioner (GP). PATIENTS AND METHODS: The study included women of all ages (mean 47.8 years) with stress, urge or mixed incontinence; 126 received individual and 404 group treatment. Both groups undertook the same pelvic floor exercises and bladder training, and received the same information. The effects were measured soon after treatment and again 9 months later. The main outcome measures were objective changes in the severity of incontinence, frequency of urine loss and frequency of nocturnal urine loss. The trial was nationwide; 25 physiotherapists and 337 GPs participated. RESULTS: There were no significant differences in effect between the groups; after individual treatment the severity of incontinence improved in 60% of the patients and the mean (95% confidence interval, CI) frequency of urine loss decreased, by -8.7 (-6.4 to -11.1) times/week. After group therapy continence improved in 57% and the frequency of urine loss decreased, by -8.4 (-6.8 to -10.0) times/week. For women who had nocturnal urine loss (at baseline), the frequency decreased after individual treatment by -11.2 (4 to -26.4) and after group therapy by -14 (-9.1 to -18.9) times/month. All improvements persisted in full for up to 9 months. CONCLUSION: Individual and group physiotherapy are equally effective for at least 9 months in improving incontinence in women. Factors should be sought that can predict the effectiveness of therapy, and thus better select those patients most likely to benefit from therapy.

Predictors of sense of competence in caregivers of demented persons.

In this study a path analytic approach was used to investigate predictors of the sense of competence in primary caregivers of demented persons. Data were gathered from 141 pairs of demented persons living in the community and their informal primary caregivers. Analysis of the information reported by the primary caregivers indicated that sense of competence and its component domains were affected above all by behavioural problems of the demented person and degree of neuroticism of the primary caregiver. No significant influence was found on the sense of competence of formal support of home helps and district nurses. The results suggested that the amount of support the demented person received from other social network members only had a limited influence on the domains of sense of competence.

Elderly people's adaptability to complete denture therapy: usability of a geriatric behaviour-rating scale as a predictor.

Accurately predicting prognosis of complete denture therapy requires a reasonable estimation of the ability of a patient to adapt. The aim of the current study was to test the usability of a geriatric behaviour-rating scale (BOP) as a predictor of elderly people's ability to adapt after complete denture therapy. Ninety-five complete denture-wearing residents of four nursing homes for somatically handicapped patients were randomly divided into two groups, 48 test subjects for whom replacement dentures were prepared and 47 test subjects whose current dentures were improved on. The results of these treatments were evaluated by comparing the scores on the so-called 'scale of appreciation' (complaints of and (dis)satisfaction with complete dentures) prior to and at 2 and 6 months post-treatment. Univariate correlations were computed between the scores on the 'scale of appreciation' or the differences in scores at the three evaluation-moments and the foremost BOP-subscale (BOP1, infirmity) and some factors that were considered to be of influence on the process of adaptation. The BOP1 was the only factor showing a significant correlation with the 'scale of appreciation' at 2 months posttreatment; this suggests that little infirmity was connected with a low value of complaints of and dissatisfaction with complete dentures or a positive alteration of this value. It is concluded that the BOP1 can be a useful predictor of complete denture therapy in this group of elderly people. A relationship between elderly people's adaptability to complete denture therapy and the BOP or any other geriatric behaviour-rating scale could be possible.

[Prosthesis treatment of nursing home residents. New prosthesis preparation or improvement of existing one?]. / Prothetische behandeling van verpleeghuisbewoners. Nieuwe prothese vervaardigen of de bestaande verbeteren?

From a clinical point of view one should show restraint in preparing new dentures for elderly people. It is advised to improve existing dentures. This research project shows that both treatments in elderly, somatically handicapped, nursing home residents do not diminish their complaints and dissatisfaction. Obviously, they are best served by a problem-centred treatment.

[Adaptation capacity of elderly to new (or improved) dentures; use of a geriatric assessment subscale]. / Het aanpassingsvermogen van ouderen aan een nieuwe (of verbeterde) gebitsprothese. Het gebruik van de BOP1-subschaal.

Elderly people's diminished adaptability is an important factor in their acceptance of new or improved dentures. This research project shows that a geriatric rating scale for infirmity may have a valuable predictive function for adaptability.

Dental health behavior and attitudes--an application of correspondence analysis.

Differences in dental behavior and dental attitudes between people with (almost) all natural teeth, people with a full denture in both jaws and people with a full denture in only the maxilla are visualized by means of correspondence analysis in one overall picture. In this picture the three distinguished subgroups of dental patients and their characteristics are indicated as points in a two-dimensional space. The distances between the points in this picture show to what extent these points are connected. The findings obtained in this study can lead to the conclusion that: a. differences in dental status are related to differences in dental behavior and dental attitudes; b. people with all natural teeth and people with a full denture in both jaws obviously are opposite of each other in many respects, whereas people with a full denture in only one jaw can be characterized as a dental in-between group.

[Differences between dentate and edentate people]. / Een sociaal-tandheelkundige 'atlas' Verschillen in kenmerken tussen mensen met en zonder gebitsprothese(n).

Differences in dental behaviour and dental attitudes between people with (almost) all natural teeth, people with a full denture in both jaws and people with a full denture in only the upper jaw are summarized by means of correspondence analysis in one overall picture. The findings obtained in this study can lead to the conclusion that: a. differences in dental status are related to differences in dental behaviour and dental attitudes; b. people with all natural teeth and people with a full denture in both jaws obviously are each other's opposites in many respects, whereas people with a full denture in only one jaw can be characterized as a dental in-between group.

Quality of dental restorations and dental treatment in Dutch schoolchildren.

The quality of dental restoration and treatment need have been defined and investigated in a survey of primary schoolchildren in the Netherlands. Measurements were made using respectively a quality of dental restorations index and a dental treatment index. A statistical analysis was carried out on these data. Six criteria were used to classify the technical quality of restorations. Quality was analysed in relation to the child's region of residence and the type of dental professional regularly visited. Three other variables were also considered to be relevant in the analysis; the size of the restorations (one or more surface fillings), the child's age, and whether the restorations were polished (finished) or not. An overall index to measure the intrinsic quality of dental restorations (QDRI) based upon five qualitative criteria was constructed. A proportional dental treatment index (DTI) was developed on the basis of sets of fillings placed and fillings needed.

[Interaction between food texture and dental health]. / De wissel werking tussen voedseltextuur en gebitsconditie.

The consistency is one of the sensoric properties of a food item and forms the origin of texture. The texture of a food item can be distinguished in hardness, toughness, stickiness, juiciness and chewability. The consistency of food items may influence dental health. It is suggested that hard food cleans the teeth. The chewing pattern depends on the texture of the masticated food. Hard and tough food require a more horizontal movement of the lower jaw, contrary to soft and tender food which mainly require a vertical movement. An adequate food texture contributes to the acceptability and the preference of food.

The subjective experience of mastication in subjects with shortened dental arches.

In this study the perception of chewing is investigated in forty-three subjects with a shortened dental arch (SDA) by means of an interview. A group of fifty-four subjects with a complete dentition was used as a control group. The aim was: (i) do subjects with a SDA have a higher risk of chewing problems, and (ii) do they have different food perception and food selection leading to change in their diet? The results show that for subjects with a SDA the chewing function, food perception, food selection and actual food consumption are hindered within an acceptable degree.